Laparoscopic modified double stapling technique with transanal resection for low anterior resection of rectal cancer

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COD: 01_2019_12_2949 Categorie: ,

Giulio Illuminati, Dimitri Krizzuk, Giulia Pizzardi, Bruno Perotti, Rocco Pasqua, Paolo Urciuoli
Ann. Ital. Chir., 2019 90, 1: 78-82

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BACKGROUND AND AIM: Anterior resection of the rectum with a total mesorectal excision is the standard surgical technique
for the treatment of rectal cancer. Laparoscopic low anterior resection (LALAR) is an alternative to open surgical
approach and was validated in diverse randomized control trials to be as safe and oncologically effective. That said, confronting
a low rectal tumor in an obese patient with a narrow pelvis can be technically challenging even for the most
expert surgeon.
METHODS: We propose a modified double stapling technique with transanal eversion and staple resection of the rectal
stump.
RESULTS: We applied the above technique in 3 patients with a dubious distal resection margin due to patient/tumor
characteristics. The mean length of operation was 272 minutes and a R0 resection with a mean number of 16 nodes
could be obtained in all the patients. No recurrence occurred during a follow-up of 28 months.
CONCLUSIONS: We conclude that this technique is a feasible, safe and valid adjunct to the double staple technique whenever
intraabdominal application of the linear staple is difficult or unsafe.